Health and Social Care Update - February 2012

07/02/12

Legal intelligence for professionals in health and social care

This Update contains brief details of recent Government publications, legislation, cases and other developments relevant to those involved in health and social care work, which have been published in the last month.

If you have been forwarded this update by a colleague and would like to receive it directly, please email Claire Bentley.

Emergency bed use - what the numbers tell us. This briefing by the Kings Fund examines why we need to understand more about bed use for emergency admissions; what progress has been made in reducing bed use; how reducing bed use can lead to improved quality of care and patient experience; and what the next steps should be.

More patients than ever before are staying in single sex accommodation. The latest statistics show that unjustified stays in mixed sex accommodation have fallen by 11,035 (94%) since December 2010. Protecting the privacy and dignity of patients is a priority for the NHS, and a record 73% of hospital trusts are now reporting zero cases, compared with 52% of trusts this time last year when new monitoring systems were introduced.

Winterbourne View: update and action needed. This letter sets out out action that needs to be taken forward by NHS bodies and local authorities following the BBC Panorama programme which revealed the systematic abuse of patients within Winterbourne View hospital. It also reminds commissioners of the minimum action that is expected to be taken in order to improve standards at a local level.

Care in crisis 2012. This report reveals that this year spending on older people’s social care in England has fallen by £500 million and the funding gap is growing. It projects that by 2012-2013 the Government would need to spend £1 billion more than this year to stop the situation getting any worse.

CasesR (Mavalon Care Ltd) v Pembrokeshire CC [2011] EWHC 3371 (Admin) (Admin Ct). The High Court has for a second time quashed Pembrokeshire CC's decision regarding the fees paid to residential care home providers. In December 2010 in R (Forest Care Home Ltd) v Pembrokeshire CC [2010] EWHC 3514 (Admin), Hickinbottom J quashed the Council’s original decision to pay £390 pw per resident in 2010/11. The council then reassessed the rate using an economic toolkit and raised its payment per resident to £464 pw. The seven claimants, care home providers that delivered 22.4% of all beds in the area, applied for judicial review of that new decision. They contended that the Council had breached its duty under s.21 of the National Assistance Act 1948 as the methodology used, which resulted in a fee of some £52 pw per resident lower than it would otherwise be, lacked any rational foundation, failed to take account of its legitimate current and future costs, did not consider what they needed in order to be viable, and gave no incentive for care home providers in the county to improve their facilities. The court held that an important part of the judgment in Forest Care Homes had been lost sight of. The clear message of Hickinbottom J's judgment was that a decision-maker who agreed to use a model, but then wished to depart from it, needed to take great care lest the departure was an inappropriate one. The council might have reached a different decision if it had had regard to the guidance about sustainability, what was stated in Forest Care Homes on the application of the toolkit, and the way in which, given the initial decision to use the toolkit, a departure from it had to be justified. The new decision would be set aside and remitted to the Council for the redetermination of the rate for 2010/11.

If you wish to discuss any of the items raised in this section please contact Carlton Sadler.

Publications/GuidanceImproving health results for children. The Secretary of State Andrew Lansley has announced that a new focus on improving care for children and young people will be unveiled later this year. The Children’s and Young People’s Outcomes Strategy will focus the health service on improving health results for children, including those needing primary, hospital and urgent care, and children with long-term conditions. It will identify health issues that matter most to children and young people, and how a modern NHS will meet their needs. To inform the strategy, the Children’s and Young People’s Health Outcomes Forum , a group of independent experts from local government, the NHS and charities, has been set up to hear views from children, parents, carers and wider families as well as health professionals. The Forum will be jointly chaired by Professor Ian Lewis, Medical Director at the Alder Hey Children’s NHS Foundation Trust, and Christine Lenehan, Director at the Council for Disabled Children.

Publications/GuidanceSpecialists in commissioning: Looking beyond current policy. This report from the NHS Alliance discusses the views of GPs and specialists on current policy on specialists in Clinical Commissioning Groups. The paper calls for policy to be more inclusive and flexible to allow both groups of doctors to develop positive relationships to enable integrated care across the primary-secondary healthcare boundaries. It proposes a transformation of the traditional relationship between GPs and specialists in the NHS, which has increasingly been limited by professional and policy constraints and requirements, rather than necessarily by an ethos of common purpose and benefit for patients and the public.

Guide for commissioners on end of life care for adults. This guide is one of a series of good practice guides by NICE to support commissioners in designing high quality, evidence-based services to improve outcomes for patients and to help the NHS make better use of resources. The guide aims to support local implementation of the DH End of Life Care Strategy and the NICE Quality Standard for end of life care for adults, and is aligned with the NHS Outcomes Framework and supports commissioning for Quality, Innovation, Productivity and Prevention (QIPP). The guide includes an end of life care commissioning and benchmarking tool to help users determine the level of service that might be needed locally and to help cost and identify potential savings associated with commissioning end of life care services.

Experience led commissioning for end of life care: Final evaluation report. The University of Westminster has carried out an independent evaluation of the effectiveness of "experience led commissioning" (ELC) in improving end-of-life care. ELC is a commissioning methodology based on patient experience and involvement. This report presents the results of the evaluation of the DH funded ELC pilot in end of life care. Overall, the evaluation was favourable about the delivery of ELC, highlighting some process issues that will require attention in moving into the next phase, and when delivering future ELC projects.

Winterbourne View: update and action needed. This letter sets out out action that needs to be taken forward by NHS bodies and local authorities following the BBC Panorama programme which revealed the systematic abuse of patients within Winterbourne View hospital. It also reminds commissioners of the minimum action that is expected to be taken in order to improve standards at a local level.

Resources for clinical commissioning groups. These are resources which may be useful for emerging clinical commissioning groups (CCGs). They include guidance and process documents, toolkits and other information around authorisation, governance, establishment and commissioning support.

If you require further information about any of the items raised in this section please contact David Owens.

Publications/GuidanceLeadership and management for all doctors. This guidance sets out the wider management and leadership responsibilities of all doctors in the workplace, including: responsibilities relating to employment issues; teaching and training; planning, using and managing resources; raising and acting on concerns; and helping to develop and improve services. It comes into effect on 12 March 2012.

Raising and acting on concerns about patient safety. This guidance sets out expectations that all doctors will, whatever their role, take appropriate action to raise and act on concerns about patient care, dignity and safety. The guidance comes into effect on 12 March 2012.

Advice on appointment of Directors of Public Health. This "Dear Colleague" letter from Professor Dame Sally C Davies, Chief Medical Officer, and Carolyn Downs, Chief Executive, LGA, provides advice and support to local areas on appointing Directors of Public Health to vacant posts in upper tier and unitary local authority areas and on transferring those already in post from the NHS.

NHS Standard Contract 2012/13 (bilateral). Following the publication of the new NHS Standard Contract 2012/13 on 23 December 2011, the DH has now published the bilateral version. It brings together the previous four core contracts into a single restructured contract and is for use by commissioners when commissioning NHS funded acute, ambulance, community and mental health and learning disability services from all types of providers.. The NHS Standard Contract for 2012/13 reflects the requirements set out in the 2012/13 NHS operating framework. There is also supporting guidance and flow charts.

Liberating the NHS: Developing the healthcare workforce - From design to delivery. Sets out the DH's policy framework for a new approach to workforce planning and the education and training of the health workforce that puts employers and professionals in the driving seat and gives them the national support they need to identify and anticipate the key workforce challenges, and to be flexible and responsive in planning and developing their workforce. The two central planks to the new system are Health Education England (HEE) and the Local Education and Training Boards (LETBs).

Implementing the Equality Act 2010: interim guidance for the NHS. The Equality Act includes specific deadlines that all public bodies are legally required to meet. NHS Employers has published interim guidance to support NHS organisations with this. The guidance signposts the best advice and answers the most popular questions asked in relation to employer responsibilities.

Service-line management: can it improve quality and efficiency? This paper presents the findings from a series of interviews with staff at seven NHS trusts that are using service-line management (SLM) or service-line reporting, revealing how they are implementing this approach and identifying what helps and what hinders this way of working. It outlines a number of important issues for trusts to consider when introducing SLM.

ConsultationsRecognising and approving trainers: a consultation. The GMC is proposing new arrangements for recognising and approving trainers. The consultation is seeking feedback on these new proposed arrangements and invites comments on a number of questions arising from those recommendations. The consultation will end on 30th March 2012.

Summary of consultation responses: proposed duty of co operation. The document summaries the responses received for this consultation together with a list of organisations that responded. The draft regulations duty of co-operation would have placed certain duties on employers, contractors and other designated bodies relating to health care workers. The duties would have involved the sharing and providing of information relating to the conduct or performance of a worker if there is a potential risk to patient safety. The Government has decided not to proceed with developing the regulations because respondents were unconvinced of the need for further legislation in this area. Read a summary of the responses received. The original consultation to seek views on draft regulations on “duty of co-operation” took place between 5 March and 9 July 2010.

Bevan Brittan Updates2012 – What to expect in employment law. 2012 is set to be another bumper year for development and change within employment law and processes. Jaspal Basra takes you on a quick run through of some of the significant changes that are expected in the months ahead, including legislative change, reforms and upcoming judgments.

News round up. Alessandra Gettins reports on the latest employment news: looking ahead to the 2012 Olympics; application of the new qualifying period for unfair dismissal; publication of the most recent tribunal statistics; and a recent case focusing on the implications of the abolition of the default retirement age.

Overtime and the Working Time Regulations. Julian Hoskins discusses the recent judgment by the EAT in the case of Arriva London South Ltd v Nicolaou UKEAT/0293/11 which held that a requirement by an employer for an employee to sign an opt-out agreement in order to work overtime was not a detriment and was necessary to ensure the employer complied with its duty under the Working Time Regulations 1998.

Publications/GuidanceAccelerating the release of surplus public sector land for development. The Deputy NHS Chief Executive David Flory has written to NHS Chief Executives reminding them of how the initiative to accelerate the release of public sector land for development can assist in disposing of surplus land. The next annual surplus land data collection is taking place this month and will assist in quantifying the contribution of the NHS to this ongoing initiative.

Charitable assets relating to the PCT estate and related assets. This letter is from David Flory trying to establish what 'estates assets' (i.e. land and buildings, equipment, investments and cash) are currently held by or on behalf of PCTs on trust ahead of the proposed abolition of PCTs, so that arrangements can be made in relation to those assets.

Publications/GuidanceCan NHS hospitals do more with less? This review of hospital efficiency has found that there are many ways in which hospitals could improve efficiency and reduce the need for cutbacks in services for patients. It cites length of stay and day surgery rates as examples of where there are still opportunities for efficiency to be improved.

Delivering sustainable cost improvement programmes. The Audit Commission and Monitor have published a guide aimed at acute, ambulance, mental health and specialist NHS trusts and foundation trusts that summarises how successful organisations approach the delivery of cost improvement programmes. It states that success varies among trusts and there is no single approach that will work for all organisations. A successful cost improvement programme saves money but also, through long-term plans to transform clinical and non-clinical services, improves patient care, satisfaction and safety. Organisations should use the briefing and the supporting questions to review their own performance and identify areas for improvement.

Reference costs guidance for 2011-12. Reference costs are the average unit cost to the NHS of providing defined services in a given financial year to NHS patients in England and are collected annually. This guidance sets out the mandatory requirements for the collection of 2011-12 reference costs from NHS trusts and NHS foundation trusts.

NHS costing manual. This manual sets out mandatory and minimum principles and practices that must be applied to costing in the NHS. They are designed to support the calculation of reference costs, and through these, the national tariff, but can also be applied to other costing models.

Report of the Office of Health Economics Commission on competition in the NHS. This report recommends careful expansion of competition between providers of NHS-funded health care in England. It finds that competition in the NHS is controversial, but in the right circumstances it can be used to stimulate the provision of better health care than is achieved without competition. Three background reports are also available alongside the final report of the commission.

NHS Trusts to receive funding support. The DH has announced up to £1.5bn support over 25 years for 7 NHS Trusts with historic PFI arrangements that were unable to demonstrate the necessary long-term financial viability. The hospitals are: Barking, Havering and Redbridge NHS Trust Dartford and Gravesham NHS Trust Maidstone and Tunbridge Wells NHS Trust North Cumbria NHS Trust Peterborough and Stamford Hospitals NHS Foundation Trust South London Healthcare NHS Trust St Helens and Knowsley NHS TrustTo meet the criteria for such support, the shortlist of affected Trusts had to demonstrate that they had met four key tests: The problems they face should be exceptional and beyond those faced by other organisations; They must be able to show that the problems they face are historic and that they have a clear plan to manage their resources in the future; They must show that they are delivering high levels of annual productivity savings; They must deliver clinically viable, high quality services, including delivering low waiting times and other performance measures.

Sustainability in the NHS: health check 2012. This report highlights how sustainability is viewed by leaders in the health service and demonstrates the public’s desire for a more sustainable healthcare system. It also indicates how sustainability can save NHS organisations money as well as saving the environment.

If you require further information about any of the items raised in this section please contact David Owens.

Publications/GuidanceSecond stage of board governance guidance for aspirant foundation trusts. The second stage of the Board Governance Assurance Framework – the Development Modules – is available. The modules cover quality governance, organisational strategy and values, and financial governance. In December 2011, the Department published the first stage of the assurance framework, which is a mandatory Board Governance Memorandum for all aspirant Foundation Trusts.

If you require further information about any of the items raised in this section please contact Vincent Buscemi.

Publications/GuidanceBuilding the NHS Trust Development Authority. From April 2013 the NHS Trust Development Authority (NTDA) will provide governance and oversight of NHS trusts, supporting them to NHS foundation trust status. This document explains the purpose of the NTDA as a special health authority, its process, its people and its relationships with other parts of the NHS.

Risk appetite for boards. Treasury guidance requires the boards of all public sector organisations to publish a public statement of risk appetite. These publications aim to support boards around risk appetite as well as informing partners, suppliers and commissioners on this topic.

NHS audit committee handbook. This publication is designed to assist NHS boards and audit committees as they review and continually reassess their system of governance, risk management and internal control to ensure that it remains effective and ‘fit for purpose’ in providing them with the assurance they require.

Second stage of board governance guidance for aspirant foundation trusts. The second stage of the Board Governance Assurance Framework – the Development Modules – is available. The modules cover quality governance, organisational strategy and values, and financial governance. In December 2011, the Department published the first stage of the assurance framework, which is a mandatory Board Governance Memorandum for all aspirant Foundation Trusts.

Resources for clinical commissioning groups. These are resources which may be useful for emerging clinical commissioning groups (CCGs). They include guidance and process documents, toolkits and other information around authorisation, governance, establishment and commissioning support.

If you require further information about any of the items raised in this section please contact Vincent Buscemi.

Publications/GuidanceRisk appetite for boards. Treasury guidance requires the boards of all public sector organisations to publish a public statement of risk appetite. These publications aim to support boards around risk appetite as well as informing partners, suppliers and commissioners on this topic.

NHSLA Risk Management Standards 2012-13. These manuals are be used as the basis for assessments from 1 April 2012. Changes to the standards and assessment process since the previous version can be found in Appendix E. The rationale and references for each criterion, which previously appeared in a separate handbook, have now been incorporated into the standards manual.

Raising and acting on concerns about patient safety. This guidance sets out expectations that all doctors will, whatever their role, take appropriate action to raise and act on concerns about patient care, dignity and safety. The guidance comes into effect on 12 March 2012.

Never events list update for 2012/13. The ‘never events’ list has been updated and published with minor amendments to two of the never event definitions. The changes are to ‘never event’ number 18, ‘Transplantation of ABO incompatible organs as a result of error’ and ‘never event’ number 23, ‘Misidentification of patients’. The never events list for 2012/13 sets out the revised list and definitions for use in the NHS in 2012/13.

If you wish to discuss any of the items raised in this section please contact Joanna Lloyd.

Bevan Brittan TrainingBevan Brittan’s annual mental health seminars will be taking place on 28th February in Birmingham and 14th March in London. The London seminar is now full. If you have been allocated a place and are unable to attend please let Claire Bentley know as we have a waiting list of people who would like to attend. There are a couple of remaining places for the Birmingham seminar. Please contact Claire Bentley if you are interested.

Bevan Brittan Mental Health Extranet. Free resource for Bevan Brittan NHS clients. Bevan Brittan has a wealth of mental health knowledge it would like to share with NHS clients. We have therefore developed an online searchable extranet designed to bring various sources of mental health information and guidance into one place. The extranet also contains a forum for use by members to share knowledge and information. If you would like information about how to access the Bevan Brittan Mental Health Extranet please email Claire Bentley by clicking here. Issues currently being discussed are:-

Publications/GuidanceLearning disability reports. The CQC have published ten reports from its review of services for people with learning disabilities The programme is looking at whether people experience safe and appropriate care, treatment and support and whether they are protected from abuse. A national report into the findings of the programme will be published in the Spring. The ten inspections were of hospitals that provide assessment and treatment services.

Mental health community teams activity. This page links to quarterly data on new cases taken on by Early Intervention in psychosis services, the number of patients on Care Programme Approach, followed up within seven days of discharge from psychiatric inpatient care, and gate-keeping inpatient admissions by Crisis Resolution Home Treatment teams.

National survey of investment in mental health services for 2011-12. Mental Health Strategies is a long established leading provider of support to organisations wishing to improve mental health services across the health and social care fields and actively engages with NHS providers and commissioners as well as the independent sector. The National Survey of Investment in Mental Health Services for the 2011-12 collection is an ongoing exercise. This is the tenth national survey exercise for working age adults and the sixth for older adults. The data aims to provide detailed analysis on spending in mental health services which can help Ministers in answering parliamentary questions. It should also assist the Department and local authorities in formulating policy for the provision of mental health services. This dear colleague letter explains about the responsibility of local implementation teams leads to co-ordinate, collect, review and return all data to Mental Health Strategies. The deadline for submitting data is 23 March 2012.

Developing an outcomes-based approach in mental health. The Department of Health commissioned the Mental Health Network to produce a report which would help set out a direction of travel for developing an outcomes-based approach to improving mental health. The report makes a number of recommendations for Government, the NHS Commissioning Board and emerging clinical commissioning groups. This briefing sets out the policy context for outcomes in mental health and summarises the recommendations made in the report, including the need to develop an implementation framework in support of the mental health strategy, 'No health without mental health'.

IAPT accreditation advice. Formal accreditation procedures and standards are the primary means for ensuring the IAPT workforce is capable of delivering NICE approved therapies appropriately and effectively. This advice identifies the relevant professional bodies involved in the accreditation of IAPT approved therapies and summarises their accreditation requirements.

NHS Standard Contract 2012/13 (bilateral). The new bilateral version of the NHS Standard Contract 2012/13 is for use by commissioners when commissioning NHS funded acute, ambulance, community and mental health and learning disability services from all types of providers. There is also supporting guidance and flow charts.

Making Best Interests decisions: People and processes. The Mental Health Foundation, in partnership with the Norah Fry Research Centre at the University of Bristol and the Centre for Applied Social Research at the University of Bradford, have published a report calling for the Mental Capacity Act (MCA) Code of Practice to be revised to enable health and social care staff to make more effective best interests decisions.

Defining mental health services: promoting effective commissioning and supporting QIPP. In mental health there has not been a consistent set of definitions that describe what is meant by an inpatient bed. This has led to difficulty in benchmarking and understanding patterns of performance. This report seeks to address those variations of understanding by suggesting a range of definitions that can be used by commissioners and service providers.

CasesK v (1) LBX (2) L (By his litigation friend the Official Solicitor) (3) M [2012] EWCA Civ 79. Article 8 should not be the starting point when considering best interest issues under the MCA 2005. A judge should firstly apply the checklist of factors in s4 MCA 2005 in order to determine the best interests of the incapacitated adult, and then consider whether the result amounted to a violation of the persons Article 8 rights and then consider whether that violation was necessary and proportionate.

Rabone v Pennine Care NHS Foundation Trust (2012) UKSC 2. Article 2 of the European Convention on Human Rights 1950 imposed an operational obligation on states to protect mentally ill patients who were not detained under the Mental Health Act 1983 where there was a real and immediate risk of suicide. The parents of the patient were direct victims of the breach under the Convention. They had not lost their victim status by settling the negligence claim. A full summary and implications of this case is being prepared and will be published on the Bevan Brittan Mental Health Extranet.

Re Neary; Hillingdon LBC v Neary [2011] EWHC 3522 (COP). The court summarises 5 Court of Protection decisions on costs in an appendix to the judgment and shows how the court has exercised its powers previously. Each application must be considered on its own merit. Departure from the general rule that each party bear their own costs is justified on the facts of this case. The approach taken by Hillingdon was unreasonable as a result of its disorganised decision-making, the lack of proper assessment of Steven’s best interests, its uncooperative attitude towards Mr Mark Neary, its delay in referring the matter to the court (thereby increasing costs), and its attempt to defend its actions to the end, both in court and in the media. Costs were ordered to be paid by Hillingdon on the standard basis from the date of issue to the conclusion of the main hearing which was from December to May. Payment between May and July was spent in co-operative efforts between the parties and did not attract a costs award. There was no order in relation to the costs of the press issues.

ConsultationsConsultation on low secure services and psychiatric intensive care. Consultation documents on low secure services and psychiatric intensive care have been issued for a three month consultation by stakeholders. The purpose of this consultation is to invite the views of stakeholders on how new guidance will operate by explaining the rationale behind the strategic approach and raising questions which cover a broad range of issues. This consultation will close on 19 April 2012.

InquiriesAn independent investigation into the care and treatment of service user Ms Z. December 2011. Ms Z stabbed and killed her boyfriend, Mr Y, on 21 September 2007. This report for NHS London sets out the findings of an independent investigation into Ms Z's mental health care and treatment before her arrest. The report contains a number of recommendations relating to general improvements to team working but does not believe that any action or inaction by individuals and teams who cared for Ms Z had a direct causal link to the homicide.

If you wish to discuss any of the items raised in the above section please contact Simon Lindsay.

Charitable assets relating to the PCT estate and related assets. This letter from David Flory, Deputy NHS Chief Executive, to cluster PCT chief executives requests information on what estates assets (i.e. land and buildings, equipment, investments and cash) are currently held by or on behalf of PCTs on trust ahead of the proposed abolition of PCTs. It follows the announcement on 4 August 2011 regarding the future ownership and management of estate in the ownership of PCTs in England.

Choice of GP practice: guidance for PCTs. This guidance aims to provide PCTs with the support tool they need to prepare for the implementation of widening patient choice of GP practices. The guidance provides more information on the arrangements that need to be in place for providing patients a wider choice on selecting GP practices.

Resources for clinical commissioning groups. These are resources which may be useful for emerging clinical commissioning groups (CCGs). They include guidance and process documents, toolkits and other information around authorisation, governance, establishment and commissioning support.

NewsNHS to get £100m cash injection to improve services. The DH has announced that it is providing up to £100m in additional funding to doctors in emerging Clinical Commissioning Groups to improve local services and reduce pressures on the NHS during the colder months. CCG clinicians must spend the money directly on local care services that best meet their patients' clinical needs and prevent unnecessary admissions to hospital. PCT clusters will be required to inform their SHA cluster by the end of February 2012 on how their share of the frontline commissioning funding has been utilised. Any funding which will not be used must be returned to the DH by the middle of February to spend on patient care elsewhere in the NHS.

Publications/GuidancePutting the quality into the Care Quality Commission (CQC). This report details the findings from a survey of more than 5,000 RCN members about the health care regulator, CQC. It found that although nurses support the CQC and welcome the improvements it has recently made, there is more work to do to fully understand issues such as staffing levels and skill mix when undertaking assessments.

If you wish to discuss any of the items raised in this section please contact Carlton Sadler.

Publications/GuidanceNHS Litigation Authority Industry Review. The Department of Health has published the report of the NHS Litigation Authority (NHSLA) Industry Review and the Department’s response. The Department welcomes the report, which highlights the positive role of the NHSLA and the effective contribution it has made since its establishment in 1995. The Department broadly accepts the report, its conclusions and recommendations. The Department’s response sets out actions that will be taken forward as a result of the review undertaken by Marsh Ltd between February and April 2011. A process of engagement will now begin with stakeholders by the NHSLA and the Department to look at how particular recommendations will be implemented or where further policy development needs to be undertaken.

Personal health budgets and NHS Continuing Healthcare discussion paper. This paper explores personal health budgets for people receiving NHS Continuing Healthcare (NHS CHC). It defines personal health budgets and NHS CHC, and gives more information about the recent Government announcement. It discusses how personal health budgets are relevant to people receiving NHS CHC and how personal health budgets change the NHS CHC pathway. It also goes through some practical considerations and next steps, and gives some useful case studies and Q&As.

Care planning and diabetes. A new edition of the NHS Diabetes Knowledge and Information Repository series has been launched, covering care planning and diabetes. It provides an overview of diabetes care planning and synthesises key policy papers; national body statements; clinical and care guidelines; and key research and evaluation papers.

Report of the Office of Health Economics Commission on competition in the NHS. This report recommends careful expansion of competition between providers of NHS-funded health care in England. It finds that competition in the NHS is controversial, but in the right circumstances it can be used to stimulate the provision of better health care than is achieved without competition. Three background reports are also available alongside the final report of the commission.

Can governments do it better? Merger mania and hospital outcomes in the English NHS. This study by the Centre for Market and Public Organisation, Bristol Institute of Public Affairs, finds that mergers are unlikely to be the most effective way of dealing with poorly performing NHS hospitals. It looks at the wave of hospital consolidation in the late 1990s and early 2000s in which around half the acute hospitals in England were involved in a merger and finds that these mergers brought few benefits. It examines the impact of mergers on a large set of outcomes including financial performance, productivity, waiting times and clinical quality and finds little evidence that mergers achieved gains other than a reduction in activity. Given that mergers reduce the scope for competition between hospitals the findings suggest that further merger activity may not be the appropriate way of dealing with poorly performing hospitals.

Preventing emergency readmissions to hospital: a scoping review. This report reviews the evidence and potential for use of 'emergency readmissions within 28 days of discharge from hospital' as an indicator within the NHS Outcomes Framework. It draws on a rapid review of systematic reviews, complemented by a synopsis of work in four countries designed to better understand current patterns of readmissions and the interpretation of observed patterns.

ExtraCare well-being: review of 2011. This report summarises some of the key points that the charity has encountered over the last year. It focuses on ExtraCare's Fracture-Free project, funded by a grant from the Department of Health, which looks to reduce the impact of fractures for residents by detecting previously undiagnosed osteoporosis.

RCN lone working survey 2011. This survey finds that over 60 per cent of nurses working in the community have been subjected to abuse in the past two years. The RCN is calling on employers to do all they can to protect their nursing staff and is urging all lone working nurses to consider the risks and act with caution at all times.

The Commission on Assisted Dying. This report by Demos concludes that the current legal status of assisted suicide is inadequate and incoherent. It finds that while the current legal regime can be distressing for the people affected and their families, it is also unclear for health and social care staff, and lays a burden on police and prosecutors, which could be eased by a new statutory framework. A proposed legal framework for assisted dying is laid out in detail, including strict criteria to define who might be eligible to receive assistance and robust safeguards to prevent abuse of any new law.

Healthy lives, healthy people - Improving outcomes and supporting transparency. The new public health system will be refocused around achieving positive health outcomes for the population and reducing inequalities in health, rather than focused on process targets, and will not be used to performance manage local areas. This Public Health Outcomes Framework sets out the desired outcomes for public health and how these will be measured. It focuses on two high-level outcomes: increased healthy life expectancy; and reduced differences in life expectancy and healthy life expectancy between communities. The framework covers the roles of local government, the NHS and Public Health England, and their delivery of improved health and wellbeing outcomes for the people and communities they serve. From April 2013, local authorities will be given a ring-fenced budget (sharing around £5.2bn based on 2012/13 funding) which they can choose how to spend according to the needs of their population. They will also be paid a new health premium for the progress they make against the public health indicators.

Protecting independence: the voluntary sector in 2012. This report from the Panel on the Independence of the Voluntary Sector identifies statutory funding, and the way that public services are commissioned, as the source of much concern. It also identifies other challenges such as: an inability for the sector to influence design, delivery and funding models; the increasing blurring of boundaries between private, public and voluntary sectors; the risk of self-censorship and challenges to the sector’s independence of voice; the pressures on independent governance; and the need for regulations and safeguards that protect, and do not hinder, independence.

NHS 111: getting lost in translation? According to a recent NHS Alliance survey, the new urgent care telephone number NHS 111 has the potential to bring real benefits to the health care system but is in danger of ‘getting lost in translation’. It found that the new clinical commissioners currently feel a lack of engagement with NHS 111, despite the fact that they are the key people responsible for its implementation across England by April 2013.

ConsultationsConsultation on the regulations for Healthwatch England membership. Healthwatch England will be a national consumer champion that enables the collective views of the people who use health and social care services to influence national policy, advice and guidance. This consultation seeks views on the key issues in relation to the membership of Healthwatch England that the Department has heard from stakeholders. The consultation closes on 2 March 2012.

JSNAs and joint health and well-being strategies – draft guidance. Seeks views on draft statutory guidance on joint strategic needs assessments (JSNAs) and health and wellbeing strategies. The guidance: lays out the statutory duties that underpin the production of JSNAs and joint health and wellbeing strategies by the NHS and local authorities as members of their health and wellbeing board; describes a framework that will lead to best practice in the preparation of JSNAs and assist with undertaking new joint health and wellbeing strategies; explains how JSNAs, joint health and wellbeing strategies and commissioning plans fit together in the new system; and sets out how the enhanced JSNA process and joint health and wellbeing strategy will enable the NHS and local government, working with their community and partner organisations, to make real improvements to the health and wellbeing of local people. Comments are required by 17 February 2012.

Proposals to reform and modernise the NHS (Pharmaceutical Services) Regulations 1992. The Welsh Government is seeking views on proposals to amend the process by which applications to provide NHS pharmaceutical services are determined. The National Health Service (Pharmaceutical Services) Regulations 1992 (SI 1992/662) (as amended) will be consolidated and replaced with new regulations. The consultation closes on 27 April 2012.

NewsThe NHS will support women with PiP breast implants. The Chief Medical Officer, Dame Sally Davies, has written to health professionals, with some more detailed guidance. The latest advice from the NHS and plastic surgery experts is that women with PiP breast implants do not need to have them removed unless they have symptoms such as pain and tenderness. There is no link to cancer and there is no clear evidence of an increased risk of harm compared to other brands of breast implants.

Patients not paperwork. During two visits to hospitals in NW England on 6 January 2012, the Prime Minister talked about the Government’s drive to ensure that every patient is cared for with compassion and dignity in a clean environment.

NHS plans: Unions move to 'outright opposition'. The BBC reports that the Royal College of Nursing and the Royal College of Midwives have joined others in stating their "outright opposition" to the Government's NHS plans in the Health and Social Care Bill. The Bill is currently being debated in the Lords' Committee.

Roll-out of telehealth and telecare to benefit three million lives. the Minister for Care Services Paul Burstow has reaffirmed his commitment to the 3millionlives initiative that aims to to enhance the lives of 3m people over the next five years by accelerating the roll-out of telehealth and telecare in the NHS and social care. He confirmed the approach to delivery of telehealth and telecare, and launched a Concordat between the DH and the telehealth and telecare industry.

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